Healthcare Provider Details

I. General information

NPI: 1497888168
Provider Name (Legal Business Name): ORAL SURGERY & DENTAL IMPLANT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2007
Last Update Date: 03/23/2024
Certification Date: 03/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

65 W MAIN RD
MIDDLETOWN RI
02842-4933
US

IV. Provider business mailing address

65 W MAIN RD
MIDDLETOWN RI
02842-4933
US

V. Phone/Fax

Practice location:
  • Phone: 401-848-0070
  • Fax: 401-848-2225
Mailing address:
  • Phone: 401-848-0070
  • Fax: 401-848-2225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License NumberDEN2276
License Number StateRI

VIII. Authorized Official

Name: MRS. VALERIE MERCER
Title or Position: OFFICE MANAGER
Credential:
Phone: 401-848-0070